Quality of Primary Care and Hospital Admissions for Diabetes Mellitus in England
Quality of Primary Care and Hospital Admissions for Diabetes Mellitus in England
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DOI：
10.1097/01.jac.0000324668.83530.6d
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发表时间：
2008-07-01
影响因子：
2.3
通讯作者：
Majeed, Azeem
中科院分区：
文献类型：
--
作者：
Bottle, Alex;Millett, Christopher;Majeed, Azeem
英格兰的国家卫生服务体系近年来投入了大量资金，以改善糖尿病等慢性病患者的基层医疗服务质量。这项投资的一个主要目的是减少相关的并发症发生率，并降低随后的住院率。这项研究的目的是检查英国初级保健服务质量与糖尿病住院率之间的关系。采用生态横断面研究设计。英格兰的303个初级保健信托基金参与了质量措施的公开报告和绩效挂钩报销，包括与糖尿病护理相关的措施。在英格兰，共有1，760，898名糖尿病患者在8441个家庭诊所登记。将住院率（糖尿病总住院率、酮症酸中毒住院率）与护理质量评分、糖尿病患病率和社区社会经济状况进行比较。我们发现，尽管在新的家庭医生合同的第一年，全国糖尿病总入院人数的变化是10倍，但在质量指标上得分一致。60岁及以上患者的初级保健质量评分与住院率之间存在显著但微弱的负相关，血糖控制与总住院率之间的相关系数为-0.21（P < .001）。在25-59岁（r = 0.58; P <0.001）和60岁及以上（r = 0.45; P <0.001）的患者中，社区社会经济地位与总住院率的相关性比质量评分更强。护理质量评分和患病率数据仅在实践层面而非患者层面可用。提高初级保健服务的质量可能会导致老年糖尿病患者对医院服务的需求适度减少。然而，低邻里社会经济地位与糖尿病住院率更密切相关。
The National Health Service in England has invested substantially in recent years to improve the quality of primary care services for patients with chronic diseases such as diabetes. A key aim of this investment is to reduce associated complication rates and decrease consequent hospital admission rates. The goal of the study was to examine associations between the quality of primary care services and hospital admission rates for diabetes mellitus in England. An ecological cross-sectional study design was used. Three hundred three primary care trusts in England participated in the public reporting and performance-linked reimbursement of quality measures, including measures relevant to diabetes care. A total of 1,760,898 persons with diabetes registered with 8441 family practices in England. Hospital admission rates (total admissions for diabetes, admissions for ketoacidosis) were compared with quality of care scores, diabetes prevalence and neighborhood socio-economic status. We found a 10-fold variation across the country in total admissions for diabetes despite uniformly high scores on quality measures over the first year of the new family practitioner contract. Significant but weak inverse associations were found between primary care quality scores and hospital admission rates in patients aged 60 years and older, with a correlation coefficient of -0.21 (P < .001) between glycemic control and total admissions. Neighborhood socioeconomic status was more strongly correlated with total hospital admission rates than quality scores in patients aged 25-59 years (r = 0.58; P < .001) and 60 years and older (r = 0.45; P < .001). Quality of care scores and prevalence data were available only at the practice level rather than at the patient level. Improving the quality of primary care services may lead to modest reductions in demand for hospital services among older patients with diabetes. However, low neighborhood socioeconomic status is more strongly associated with hospital admission rates for diabetes.